Proefschrift Kerklaan

Worldwide survey of nutritional practices in PICUs

(32%), vomiting (75%), reduced/altered bowel sounds (23%), hemodynamic instability (62%), or use of muscle relaxants (12%). Early PN would be started within 48 hours after admission in 55% of PICUs, while in 3.5% of PICUs there would be trials of EN for at least 7 days before starting PN (Fig. 3). When EN was insufficient, respondents from 18% of the PICUs would always supplement PN, whereas in 7.5% supplemental PN would never be utilized. Seventy-two percent supplemented PN if EN failed to meet 50% of target calories; 24% if EN failed to meet 80%. PN was stopped in 64% of PICUs when EN covered more than 80% of the nutritional targets. At themoment of our point prevalence 73%of the children received EN ( n = 216), predominantly by gastric tube (70%). There was no difference in caloric intake ( p = 0.82) or in prokinetics use ( p = 0.47) between children fed by gastric or postpyloric route. Forty-two percent of children with LOS less than 24 hours ( n = 43) were already receiving EN, and in children with LOS of 2 days or more ( n = 253), EN was provided in 78% . Twenty-one percent of all children received PN in some form and 10% received a combination of EN and PN; both groups at a median LOS of 6.5 days. The point prevalence showed that the ability to administer exclusive EN was overestimated; 40% of children ( n = 74) present during the point prevalence achieved exclusive EN later than perceived by the respondents from the first part of the survey .

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Figure 3. Time to initiation of enteral nutrition (EN) and parenteral nutrition (PN) based on survey data. Boxes represent the percentages of PICUs

Glucose and glycemic control In the first part of the survey , target intake of glucose during the first 12-24 hours of admission varied between less than 2 to more than 6 mg/kg/min for different weight ranges (Fig. 4). In 62% of the PICUs, a protocol for some form of glycemic control was available. Target blood glucoses were defined as less than 10 mmol/L (< 180 mg/dL) in 54% and less than 8 mmol/L (< 144 mg/dL) in 23%. Tight glucose control (2.8-4.4 mmol/L or 50-80 mg/dL < 1 year or 3.9-5.5

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